Healthcare Provider Details
I. General information
NPI: 1053901249
Provider Name (Legal Business Name): CONCORD PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/21/2021
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4995 BRADENTON AVE STE 130
DUBLIN OH
43017-3551
US
IV. Provider business mailing address
4995 BRADENTON AVE STE 130
DUBLIN OH
43017-3551
US
V. Phone/Fax
- Phone: 614-580-6917
- Fax:
- Phone: 614-580-6917
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084A0401X |
| Taxonomy | Addiction Medicine (Psychiatry & Neurology) Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
SCOTT
DEAN
YOHO
Title or Position: PSYCHIATRIST
Credential: D.O.
Phone: 614-580-6917